tbuckley/cabot-search huggingface dataset:
Nurse-Initiated Constipation Education (NICE) protocol: Improved health outcomes in the outpatient oncology setting.
Authors: Laura Tess, Erika Timko Olson, Emily Schafhauser
Journal: Journal of Clinical Oncology (2022)

237 Background: Many patients living with cancer experience pain requiring opioid therapy, and appreciation of the risks and benefits of opioids has grown in recent years. Opioid induced constipation (OIC) is one of the potential sequelae of opioid therapy. Evidence-based management strategies for OIC utilize lifestyle modifications and over-the-counter medications as initial steps. At a community cancer center, nurses are often the first team members identifying patients with OIC and suggesting management strategies. Thus, providing updated education and tools to nurses is an appropriate means for improving constipation management for patients living with cancer. Methods: Participants in the intervention included RNs and LPNs working in a specific region of the outpatient oncology practice. An evidence-based teaching tool was developed that included five handouts and a 20-minute pre-recorded educational presentation. Changes in nurse knowledge and confidence level were measured using a pretest/post-test design, and constipation related incidents were measured across a 2 month pre- and post-intervention period through review of the triage call tracking system. Data collection also included OIC incidents during the same timeframe. Results: 14 nurse participants completed a pre- and post-test after watching the presentation. Nursing constipation management knowledge scores increased by almost 30% and confidence ratings increased by 16.2%, indicating both an improved knowledge base and comfort level. Constipation-related incidents decreased by 39% post-implementation. Conclusions: Arming nurses with constipation management tools based on current evidence-based practices resulted in improved knowledge and comfort levels and led to decreased patient-reported incidents of constipation and OIC. Utilizing quality evidence-based tools and resources can help to prevent future negative health outcomes.
Clinical surveillance and PSA outcomes among patients with non-metastatic castration resistant prostate cancer (nmCRPC) treated with a next-generation androgen receptor inhibitor (ARI) in urology clinics with or without in-office dispensing (IOD).
Authors: Sabree Burbage, Dexter Waters, Carmine Rossi, Frederic Kinkead, Dominic Pilon, Erik Muser, Lorie Ellis
Journal: Journal of Clinical Oncology (2022)

410 Background: As use of oral therapies in prostate cancer treatment increases, IOD of oral medication has become more common. The objective of this study was to describe clinical surveillance practices and PSA outcomes in nmCRPC patients (pts) treated in clinics with or without IOD. Methods: nmCRPC pts with ≥1 ARI prescription (Rx) were identified in data from 95 US urology practices between 2018-2021. Pts were categorized into 3 groups: (1) Treated in IOD clinic and received ARI onsite within 14 days of Rx (IOD+), (2) Treated in IOD clinic but no onsite ARI receipt within 14 days of Rx (IOD-), and (3) Treated in a clinic without IOD (non-IOD). Descriptive analyses were conducted on pt characteristics, PSA and imaging data. PSA response, reported using Kaplan-Meier rates, was defined as ≥50% reduction in post-index (PI; index date = 14 days after 1 st ARI Rx) PSA compared to baseline PSA (measured within 13 weeks before 1 st ARI prescription). PSA progression was defined as ≥25% increase in PI PSA above baseline PSA. Results: 3,300 nmCRPC pts were identified (N = 615 IOD+; 2,474 IOD-; 211 non-IOD). Baseline characteristics differed for race, use of bone resorption agents and 1 st generation anti-androgens, and PSA doubling time (PSADT; table). By 6 months PI, PSA screening was observed in similar proportions of pts in IOD and non-IOD, while PSA response was observed in a higher proportion of IOD+ (80%) than IOD- (64%) or non-IOD (63%). PSA progression was observed in fewer IOD+ pts (10%) than IOD- (16%) or non-IOD (17%). PI imaging was conducted in similar proportions of pts in IOD and non-IOD clinics; however, non-IOD performed more imaging per pt and time to imaging was shorter than in IOD+ clinics. Conclusions: Differences were noted in patient characteristics and prior medication use in ARI-treated patients within IOD and non-IOD clinics. IOD+ was observed to have higher rates of PSA response, fewer patients with PSA progression, and use fewer imaging tests after ARI initiation than non-IOD or IOD-. Additional studies controlling for differences in baseline characteristics and examining longer term outcomes are needed to understand how IOD services impact quality of patient care.[Table: see text]
Evaluating clinician emotion regulation during a serious illness conversation in oncology using multimodal assessment: A pilot study.
Authors: Garrett Thomas Wasp, Satveer Kaur, Eric Andersen, Maxwell Thomas Vergo, Julia Chelen, Tor Tosteson, Paul J. Barr, Amber E Barnato
Journal: Journal of Clinical Oncology (2022)

439 Background: Clinician emotion regulation (ER), self and the patient’s, likely moderates successful prognostic discussions with patients, yet challenges around its evaluation limit its investigation. We performed a pilot study to develop and assess an experimental framework that uses multimodal assessment (self-report, observer, and biometric data) to measure clinician ER during a simulated, serious illness conversation (SIC). Methods: We developed our experimental framework in four steps: 1) drafted a patient case and assessment framework; 2) refined the data collection strategy using a multidisciplinary research team; 3) trained our actor; and 4) iteratively piloted the case to optimize data collection. For the assessment, we conducted a cross-sectional, case series pilot study with physicians trained in SIC to assess its feasibility and acceptability, defined a priori as an enrollment rate &gt;60% of approached clinicians, &gt; 90% completion rate of survey items, &lt; 20% missing data from wearable heart rate variability (HRV) sensors. To characterize clinician ER strategies, we analyzed the visit dialogue, physician interviews performed while watching the visit back, and physician SIC documentation generated post visit. We used a hybrid approach of inductive and deductive coding and theme development based on preexisting ER theory. Results: The development phase yielded two major modifications: 1) abandoned use of AppleWatch since it did not provide continuous HRV measurement; and 2) used telehealth with video given context of COVID-19 pandemic. We approached 12 physicians and 11 enrolled, of which 5 were female and 10 white, 5 were medical oncologists, and 6 specialty palliative care physicians. All participants completed all study survey items. The results of our three HRV sensors were as follows: Empatica E4 and Polar H10 met our pre-specified HRV collection in all 11 resting tasks and SIC encounters, and the Scoche R24 the benchmark in 7/11 resting tasks and 4/11 of simulated encounters. Preliminary qualitative analysis suggests investigators can characterize clinician use of intrapersonal and interpersonal ER strategies. Conclusions: The use of multimodal assessment of clinician ER in a simulated, telehealth SIC visit was acceptable and feasible.
Confirming Choosing Wisely: Inpatient thrombophilia testing.
Authors: Iuliia Kovalenko, Konstantin Golubykh, Adan Martin Cuevas Velazquez, Nadim Ammari, Maidah Malik, Manpreet Sandhu, Hafiz Qurashi, Tabinda Saleem, Anas Atrash, Saketram Komanduri, Yijin Wert, Kit Lu
Journal: Journal of Clinical Oncology (2022)

22 Background: The American Society of Hematology (ASH) Choosing Wisely campaign have created thoughtful conversations between providers and patients in recommending care that is supported by evidence to reduce duplicative testing. However, some have raised concerns regarding the impact on patient care. We provide our institutional experience in exploring the clinical feasibility of the recommendation on reducing unnecessary inpatient thrombophilia testing. Methods: This was a retrospective review of patients admitted with a diagnosis of venous thromboembolism (VTE) across the 3 hospitals in Central PA from September 2021 to December 2021. Pregnancy was an exclusion criterion. Thrombophilia workup included tests for factor V Leiden mutation, activated protein C resistance, protein S activity, antithrombin deficiency, prothrombin gene mutation, anti-cardiolipin antibodies, dilute Russell viper venom time, lupus anticoagulant, anti-beta2-glycoprotein antibodies. The cost of testing was extrapolated by institutional hospital cost reports. Descriptive statistics included reporting the categorical variables as number and percent. The categorical variables were compared between groups with the use of Fisher’s exact test or the chi-square test. Results: During our study period, 310 patients had new VTE. Of those, 47.9% had pulmonary embolism, 33.7% upper or lower extremities deep vein thrombosis (DVT), 1.6% splanchnic DVT, 14.6% multiple DVTs, and 2.2% DVTs in other locations. The median age was 64. Provoked factors were found in 269 patients (86.7%) and 41 patients (13.2%) had unprovoked VTE. Overall, 33 out of 310 patients (10%) underwent thrombophilia workup with a total of 175 tests performed. More thrombophilia testing was ordered in unprovoked group (29.3% vs 7.8%, p = 0.0003) compared to provoked. There was no difference between the amount of inpatient hematology consults in both groups (33.83% vs 47.50%, p = 0.0920). Of the hematology consult, 19 out of 118 patients (16%) had thrombophilia testing recommended by hematologist. The cost of all tests ordered outside of hematology recommendation was $34,083 (avg $344 per person). Of the group that got tested regardless of provoking factors, there was no difference between hospital length of stay (2-12 days vs 3-12 days, p = 0.0665). Anticoagulation choice was also not affected by thrombophilia testing between the two groups. Conclusions: Our experience found that many thrombophilia work up were costly and did not impact quality patient care. Despite the relatively low frequency of inpatient workup (10%), eliminating testing could save our health system approximately $136,332 per year ($34,083 per quarter). Therefore, we support ASH’s campaign in reducing inpatient thrombophilia testing. We aim to work with our administration to provide education in reducing unnecessary testing.
Clinical and nonclinical factors associated with a complete family history in a statewide quality improvement consortium.
Authors: Shayna Weiner, Manlan Liu, Elizabeth Rizzo, Jennifer J. Griggs
Journal: Journal of Clinical Oncology (2022)

149 Background: A complete family history is critical in identifying cancer patients who should be referred to genetic counseling and testing. Despite the importance of a detailed family history, defined as any cancer diagnoses in first- or second-degree relatives and their age at diagnosis, only about one third of cancer patients have a complete family history documented in their medical record. The Michigan Oncology Quality Consortium (MOQC), a physician-led consortium of oncology practices across the state of Michigan, selected documentation of a complete family history in oncology patients as a quality measure. The purpose of this study was to identify clinical and non-clinical factors associated with the quality of the family history. Methods: Beginning in 2020, MOQC began collecting completeness of documentation of cancer family history from the medical oncology records of patients with invasive cancer from MOQC practices twice per year in the Quality Oncology Practice Initiative (QOPI) database. QOPI data from 2020 and 2021 were combined for analyses. A multivariate model was built to determine the clinical and non-clinical factors, including age, sex, race, ethnicity, and cancer diagnosis, associated with documentation of a complete family history. Results: Between January 2020 and December 2021, 10,800 patients’ records were abstracted. Of these, 30% had a complete family history documented in their medical record. Factors independently and significantly associated with not having a complete family history included increasing age and Black race. Patients with breast cancer (AOR 1.94, 95% CI 1.72, 2.19) and colorectal cancer (AOR 1.2, 95% CI 1.05, 1.37) were more likely to have a complete family history than all others. Patients with prostate, pancreas, or endometrial cancer—all of which are associated with cancer syndromes—were no more likely than other patients to have a complete family history. Sex and ethnicity were not significantly associated with documentation of a complete family history. Conclusions: Patients may qualify for genetic testing based on family history alone. It is therefore crucial that clinicians know a patient’s complete family history to identify those patients eligible for genetic risk assessment. We have identified gaps in the quality of the family history with increasing age, in Black patients, and, except for breast and colorectal cancer, in patients with cancers associated with an inherited susceptibility. Our findings highlight an opportunity to improve care.[Table: see text]
Factors influencing “no treatment” decisions in advanced stage cancers.
Authors: Ogheneyoma Akpoviroro, Oghenetejiro Princess Akpoviroro, Queeneth Uwandu, Kristena Yossef, Steven Suastegui, Myriam Castagne, Elga Rodrigues, Brian Bolden, Wasique Mirza
Journal: Journal of Clinical Oncology (2022)

77 Background: Several studies have attempted to explore treatment refusal in patients with cancer (CA). We performed a study that focused on patients with advanced CAs, characterizing those in this group that refused therapy. Based on this study, we sought to determine if some variables significantly correlated with ‘no treatment’ decisions, compared with a group of similar patients who accepted therapy. Methods: Our inclusion criteria were patients aged 18-75 years, diagnosed with stage IV CAs (per the American Joint Committee on Cancer staging) between 1/1/2010 and 12/31/2015 and refused therapy (Cohort 1). A randomly selected group of patients with stage IV CAs who accepted treatment in the same timeframe were used for comparison (Cohort 2). We used Proc SurveySelect and a simple random sampling method to create Cohort 2. Geisinger Health System’s data was used. Results: We found 508 patients for cohort 1, and 100 patients for cohort 2. The significance level was &lt; 0.05. Female sex was associated with treatment acceptance (51/100, 51.0%) compared with refusal (201/508, 39.6%); p = 0.03. There was no association between treatment decision and race, marital status, BMI, tobacco use, previous CA history, or family CA history. Government-funded insurance was associated with therapy refusal (337/508, 66.3%) than acceptance (35/100, 35.0%); p &lt; 0.0001. Cohort 1 had an older population compared with cohort 2 (p &lt; 0.0001). The mean age of cohort 1 was 63.1 years (standard deviation (σ) 8.1), and 59.2 (σ 9.9) in cohort 2. The most common malignancy site in both cohorts was the respiratory system but this was not related to treatment decisions. Patients with pancreatic CA tended to refuse treatment (p = 0.0009). Only 19.1% (97/508) in cohort 1 were referred to palliative medicine, with 18% (18/100) in cohort 2; p = 0.8. There was an insignificant trend for patients who accepted treatment to have more comorbidities per the Charleston Comorbidity Index (CCI) (p = 0.08). The mean CCI in cohort 1 was 6.5 (σ 3.7), and 8.0 (σ 3.9) in cohort 2. Treatment of psychiatric disorders after CA diagnosis was inversely associated with treatment refusal (p &lt; 0.0001). Conclusions: Male sex, older age, government-funded health insurance, and pancreatic CAs were associated with treatment refusal in advanced CA patients. Those who refused treatment were not increasingly referred to palliative medicine. Treatment of psychiatric disorders after CA diagnosis was associated with treatment acceptance.[Table: see text]
Disparities in receipt of financial assistance for patients prescribed oral anti-cancer medications at an integrated specialty pharmacy.
Authors: Meera Vimala Ragavan, Scott Swartz, Mackenzie Clark, Jared White, Mimi Lo, Arjun Gupta, Tracy Kuo Lin, Fumiko Chino
Journal: Journal of Clinical Oncology (2022)

217 Background: An increasing number of patients with cancer are prescribed oral anti-cancer medications and face significant challenges in affording them. Financial assistance programs may be a critical resource to mitigate this financial burden but there are often barriers to accessing them. This study evaluated factors associated with receipt of financial assistance among patients with cancer prescribed oral anti-cancer medications. Methods: We conducted a retrospective cohort study including all patients prescribed an oral anti-cancer therapy through the University of California, San Francisco (UCSF) Specialty Pharmacy between January 1,2021 and December 31, 2021. The unit of analysis was patient-drug. Information on financial assistance, including sponsor, type, and amount secured was extracted through Vivor – a financial navigation and grant tracking tool – and linked to clinical and prescription data extracted from the institutional electronic medical record. We employed a multivariate logistic regression analysis to identify variables associated of receipt of financial assistance.Results: Of 1,357 unique patient/drug combinations, 488 (36%) received some form of financial assistance. Mean age of patients was 67 years (SD = 14, range 21-97). Patients were predominantly male (69%), lived in an urban area (42%), were retired (41%), and identified as Non-Hispanic White (61%). A minority of patients (13%) were non-English speaking. The most common type of assistance received was from a foundation (35%), followed by free drug program (24%) and copayment card (23%). Healthwell Foundation (28%) and Patient Access Network Foundation (26%) were the most common sponsors for foundation-based support. Receipt of assistance varied (Χ2 = 60.8, p &lt; 0.001) by disease state. Multivariate logistic regression indicated that patients who identified as Hispanic/Latinx ethnicity (OR 0.49, p = 0.038) or were non-English speaking (OR 0.38, p = 0.015) were less likely to receive financial assistance. Conclusions: There were disparities in receipt of financial assistance by ethnicity and primary language spoken. Some patients may not be equitably connected to existing financial resources and may be disproportionately at risk for the financial, clinical, and psychosocial implications of a high out-of-pocket cost burden. Future studies should develop and implement standardized workflows to ensure equitable access to existing financial resources for patients with cancer.
Reducing same-day cancellations of precious CT simulation slots: A quality improvement project.
Authors: Ivy Ng, Michelle Lai, Jessie Ng, Richerlyn Quindara Beltran, Kie Yin Teng, Wei Wei, Chia Ching Lee, Kathleen Viloria Pastores, Ye Lin Chiau, Jyy Yin Chuah, Cheng Nang Leong, Keah How Poon, Francis Ho
Journal: Journal of Clinical Oncology (2022)

301 Background: CT simulation (CTsim) is a prerequisite step in radiotherapy treatment. Each successfully completed CTsim brings a patient a step closer to receiving their radiotherapy. A non-attempt or unsuccessful attempt (both reflected as cancellations) also delays radiotherapy for another patient. Baseline data revealed that 33% of CTsim appointments were cancelled, of which 47% occurred on the same day. Cancellations made on the same day provides little reaction time for slots to be allocated to another patient and leads to inefficiency in resource utilisation. This project aims to reduce the cancellations occurring on the same day from 15.5% to 10% within 6 months at National University Cancer Institute radiotherapy center at Tan Tock Seng Hospital. Methods: A cause-and-effect diagram was constructed to identify reasons attributing to existing same-day cancellations. Multi-voting and Pareto analysis were conducted to identify 3 main root causes. Interventions were introduced and then tested using the Plan-Do-Study-Act approach. Run chart was used to monitor the proportion of same-day cancellations over the total number of CTsim appointments. Results: Three root causes identified were 1) no workflow to check on patient’s adequacy of preparation leading up to CTsim 2) no workflow to identify potential non-attendance 3) no take-home information detailing CTsim process. Interventions introduced included establishing workflow to assess adequacy of patients’ preparation required for successful CTsim and integrating a screening phone call to confirm patient’s attendance two days prior to CTsim appointment day and handing out information sheet detailing instructions for CTsim respectively. We achieved our target in our fourth month and sustained the results for 2 further months. Mean was 5% in the last three months. This reduction of same-day cancellation improves efficiency in resource utilisation and reduces delay in access to radiotherapy. Conclusions: Using quality improvement tools, we have successfully reduced the same-day cancellations of our precious CT simulation slots from 15.5% to 5%.
An exploratory comparative effectiveness analysis of febrile neutropenia incidence among patients with cancer receiving granulocyte colony stimulating factors.
Authors: Pamala A. Pawloski, Catherine Lockhart, Gabriela Vazquez-Benitez, Terese A DeFor, Aaron Mendelsohn, James Marshall, Erick Moyneur, Cara L. McDermott
Journal: Journal of Clinical Oncology (2022)

408 Background: We conducted an exploratory comparative effectiveness analysis comparing various G-CSF (pegfilgrastim/filgrastim) products to each other in incidence of febrile neutropenia (FN) among patients with breast, lung, colon, pancreatic, ovarian cancers or non-Hodgkin’s lymphoma (NHL) in the Biologics and Biosimilars Collective Intelligence Consortium’s (BBCIC) Distributed Research Network. Methods: We included patients aged &gt; = 20 years who, in 2015-2019, per insurance claims, received any pegfilgrastim or filgrastim products as febrile neutropenia (FN) prophylaxis during the first cycle of chemotherapy posing a high or intermediate FN risk per National Comprehensive Cancer Network guidelines. We compared the FN risk starting at day 5 following day 1 of chemotherapy receipt between products using Poisson regression model with standardized inverse probability weights and robust variance to estimate the Relative Risk (RR) and 95% Confidence intervals (CI). Results: A total of 15,941 patients received a pegfilgrastim product in cycle 1 of chemotherapy: 15,115 (95%) pegfilgrastim, 484 (3%) pegfilgrastim_cbqv, 342 (2%) pegfilgrastim_jmdb. 565 patients received a filgrastim product: 284 (50%) filgrastim, 201 (36%) filgrastim_sndz, 80 (14%) tbo-filgrastim. FN events by product were: 346 pegfilgrastim (2.3% of users), 11 pegfilgrastim_cbqv (2.3%), 8 pegfilgrastim_jmdb (2.3%), 13 filgrastim (4.6%), 5 filgrastim_sndz (2.5%), 2 tbo-filgrastim (2.5%). We found no difference in FN incidence when comparing pegfilgrastim_cbqv to pegfilgrastim (RR 0.83, 95% CI 0.41-1.69), pegfilgrastim_jmdb to pegfilgrastim (RR 1.03, 95% CI 0.56-1.92), and pegfilgrastim_jmdb to pegfilgrastim_cbqv (RR 1.11, 95% CI 0.45-2.74). Similarly, we found no difference in FN incidence when comparing filgrastim_sndz to filgrastim (RR 0.46, 95% CI 0.17-1.28), tbo-filgrastim to filgrastim (RR = 0.30, 95% CI 0.06-1.36), or tbo-filgrastim to filgrastim_sndz (RR 0.54, 95% CI 0.10-2.77). Adverse events were rare, with similar rates observed among all products. Conclusions: We observed no significant difference in FN incidence among patients when comparing various G-CSF products, including when biosimilars were compared to their reference counterparts.